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荷尔蒙加放射线治疗前列腺癌比单用放射线治疗有效

来源:WebMD 作者:Zosia Chustecka 2007-6-20
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摘要: October 5, 2006 (伊斯坦堡) -- 义大利的研究者在欧洲癌症医学会(ESMO) 第31届研讨会中表示,在放射线治疗之外加上荷尔蒙治疗局部的末期前列腺癌,比单用放射线治疗的效果更优,且可考虑将此一并用治疗的方式作为标准的照护方式。 使用促性腺释放激素 (LHRH) 致效剂,如goserelin (Zoladex, AstraZeneca) 或leuprorelin......


  October 5, 2006 (伊斯坦堡) -- 义大利的研究者在欧洲癌症医学会(ESMO) 第31届研讨会中表示,在放射线治疗之外加上荷尔蒙治疗局部的末期前列腺癌,比单用放射线治疗的效果更优,且可考虑将此一并用治疗的方式作为标准的照护方式。
  
  使用促性腺释放激素 (LHRH) 致效剂,如goserelin (Zoladex, AstraZeneca) 或leuproreline (Prostap, Wyeth Laboratories)是转移的前列腺癌的标准治疗方式,但是这些药物在疾病早期的效果仍不确定。
  
  会议中,义大利罗马Regina Elena癌症中心的Paolo Carlini医师主张应该用荷尔蒙治疗加放射线治疗来治疗早期疾病,在癌症病灶仅在局部时就治疗,而不是转移到身体其他部位时再治疗;他发表的一篇后设分析的结果显示,合并这两种治疗方式提高了多达12%的绝对利益。
  
  此一后设分析使用了七篇第三期试验的4373位病患资料,运用了两种统计方法 — 固定作用模式,假定所有的试验都有相似的真实效果;随机作用模式,假定各试验的真实效果因未知的意图而异;Carlini医师表示,两种统计模式在每一个试验终点都得到显著差异,虽然有显著的异质性,但正强调了各种试验中的病患族群差异。
  
  和单用放射线治疗相比,并用荷尔蒙和放射线可以:
  * 显著降低复发率,绝对利益为10.5%,NNT是9位病患。
  * 显著改善整体存活,绝对利益为6.2% ,NNT是16位病患。
  * 显著改善癌症相关整体存活,绝对利益为3.3% ,NNT是30位病患。
  《译注:NNT“避免一位病患罹患某种疾病所需治疗人数(number needed to treat, NNT)”》
  
  研究者也探究荷尔蒙治疗的期间长短,长期的荷尔蒙治疗对无恶化存活期(progression-free survival)有较大的冲击 ,整体利益为12.3%,相较之下,短期的荷尔蒙治疗之绝对利益为9.3%。
  
  本研究的另一位作者,同样来自Regina Elena癌症中心的Emilio Bria医师,在会中的简报时指出,并用治疗显著地增加了临床利益,至于为何并用方法较佳,Bria医师推测或许是因为各种不同因素;放射治疗加入荷尔蒙治疗所增加的效果或许是因为放射线敏感性,或是因为减少局部肿瘤,也或许是杀死了辐射能量之外的隐密的散布细胞。
  
  ESMO 31届研讨会:摘要2O。发表于October 2, 2006。

Hormones Plus Radiation Better Than Radiotherapy Alone in Prostate Cancer

By Zosia Chustecka
Medscape Medical News

October 5, 2006 (Istanbul) — Adding hormonal therapy to radiation in the treatment of locally advanced prostate cancer gives superior results to radiotherapy alone, and the combination should be the standard of care, Italian researchers told the European Society of Medical Oncology (ESMO) 31st Congress.

Treatment with luteinizing hormone-releasing hormone (LHRH) agonists such as goserelin (Zoladex, AstraZeneca) or leuproreline (Prostap, Wyeth Laboratories) is a standard approach to metastatic prostate cancer, but their role in earlier disease is still uncertain.

At the meeting, Paolo Carlini, MD, from the Regina Elena Cancer Institute, in Rome, Italy, argued that hormonal therapy should be added to radiation in the treatment of earlier cases, where the cancer has spread locally but not yet to other sites in the body. He was presenting results from a meta-analysis that showed that both modalities together offer an absolute benefit of as much as 12%.

The meta-analysis used data from 7 phase 3 trials with a total of 4373 patients and applied 2 statistical methods — the fixed-effect model, which assumes that all the trials have a similar true effect; and the random-effect model, which assumes that the true effect varies between trials around an unknown mean. Both statistical models came up with significant differences on every end point, although there was significant heterogeneity, which underscores differences in the various trial patient populations, Dr. Carlini said.

Compared with radiotherapy alone, the combination of hormones with radiation:



Significantly decreased the recurrence rate, with an absolute benefit of 10.5% and a number needed to treat (NNT) of 9 patients.
Significantly improved overall survival, with an absolute benefit of 6.2% and a NNT of 16 patients.
Significantly improved cancer-specific overall survival, with an absolute benefit of 3.3% and a NNT of 30 patients.

The researchers also looked at the duration of hormone therapy. Long-term hormone therapy had a greater impact on progression-free survival, with an overall benefit of 12.3%, compared with short-term hormone therapy, which conferred an absolute benefit of 9.3%.

Speaking at a press briefing during the meeting, another of the study authors, Emilio Bria, MD, also from the Regina Elena Cancer Institute, commented that the increased benefit from the combination was clinically significant. As to why the combination is better, Dr. Bria speculated that there might be a variety of factors at play. "The increased efficacy of radiotherapy in the presence of hormone therapy may be due to radio-sensitization, to the reduction of the local tumor burden, or perhaps to the killing of occult disseminated cells outside the irradiated volume," he said.

ESMO 31st Congress: Abstract 2O. Presented October 2, 2006.


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